DIAGNOSTIC VALUE OF MULTIPARAMETRIC ULTRASOUND EXAMINATION IN PATIENTS WITH RECURRENT TONSILITIS

Abstract

The problem of recurrent tonsillitis in the world is still highly relevant. A clear algorithm for the diagnosis and treatment of patients with this pathology is still being developed and improved. Thanks to the latest technologies, modernization of equipment and improvement of knowledge of medical workers, it is possible to diagnose this disease better and, consequently, to decide on further treatment.
 Aim. Determine the informative value of shear wave elastography as an additional objective method for the diagnostics of recurrent tonsillitis.
 Materials and methods. 24 participants were enrolled in the research. Age structure: children of primary school age (6-10 years) - 14 people, teenagers (10-15 years) - 6 people, high school age (15-17 years) - 2 people, adults (22-35 years) - 2 people. Criteria for inclusion in the research - from 4 to 6 episodes of tonsillitis per year for the last 2 years. The patients' anamnesis was carefully collected, and ENT examination, paying special attention to the presence of symptoms of "underactivity" of the tonsils, shear wave elastometry and elastography of the palatine and peritoneal tonsils were performed as one of the newest methods of ultrasound examination. Longitudinal and transverse scans of the palatine tonsils and surrounding structures were performed. The obtained data were recorded in the patient's examination card for further analysis.
 In general, the main indicators were identified, which were further analyzed - the size of the tonsils, transverse size and stiffness of the paratonsillar space, colors, which mapped the examined structures, the size of regional maxillary lymph nodes.
 Results. After collecting the participants’ anamnesis, the main common feature was identified - experiencing 4 to 6 episodes of tonsillitis per year for the past 2 years, and on ENT examination – fixation of the tonsils, which indicated fibrotic changes in the paratonsillar space, which became one of the main criteria for inclusion of patients in this research. It is an objective criterion for recurrent tonsillitis. Elastometry and elastography of peritonsillar structures revealed other important objective features of recurrent tonsillitis - the shear waves velocity (stiffness of the peritonsillar space) higher than 2.0 m/sec which is mapped in red and burgundy color. Mapping of the tonsils themselves was less informative due to insignificant clinical significance. More important was the mapping of paratonsillar spaces. An additional objective criterion was the size of the maxillary lymph nodes as regional lymph nodes for the palatine tonsils. They ranged from 10.5 mm to 20.5 mm, which is larger than normal values.
 Conclusions. According to the result of the research, the following signs of recurrent tonsillitis were identified: fixation of the palatine tonsils, increased shear wave velocity (stiffness index) in the peritonsillar space on elastometry (higher than 2 m/sec), that hypothetically, can be considered as indicating fibrosis of the peritonsillar space, mapping of peritonsillar space structures with colors from green and blue to red with areas of burgundy (in normal tissues green, blue, sometimes yellow colors are seen), enlarged maxillary lymph nodes, as regional for the palatine tonsils.
 Thus, we can confirm the high informative value of shear wave elastometry and elastography as an additional objective method of visualization in patients with recurrent tonsillitis.